Assessing the diagnostic accuracy of lung ultrasound in determining invasive ventilation needs in neonates on non-invasive ventilation: An observational study from a tertiary NICU in India.

Effective management of neonatal respiratory distress requires timely recognition of when to transition from non-invasive to invasive ventilation. Although the lung ultrasound score (LUS) is useful in evaluating disease severity and predicting the need for surfactants, its efficacy in identifying neonates requiring invasive ventilation has only been explored in a few studies. This study aims to assess the accuracy of LUS in determining the need for invasive ventilation in neonates on non-invasive ventilation (NIV) support. From July 2021 to June 2023, we conducted a prospective study on 192 consecutively admitted neonates with respiratory distress needing NIV within 24 h of birth at our NICU in Hyderabad, India. The primary objective was the diagnostic accuracy of LUS in determining the need for invasive ventilation within 72 h of initiating NIV. We calculated LUS using the scoring system of Brat et al. (JAMA Pediatr 169:e151797, [10]). Treating physicians' assessments of the need for invasive ventilation served as the reference standard for evaluating LUS effectiveness. Out of 192 studied neonates, 31 (16.1%) required invasive ventilation. The median LUS was 5 (IQR: 2-8) for those on NIV and 10 (IQR: 7-12) for those needing invasive ventilation. The LUS had a strong discriminative ability for invasive ventilation with an AUC (area under the curve) of 0.825 (CI: 0.75-0.86, p = 0.0001). An LUS > 7 had 77.4% sensitivity (95% CI: 58.9-90.8%), 75.1% specificity (95% CI: 67.8-81.7%), 37.5% positive predictive value (PPV) (95% CI: 30.15-45.5%), 94.5% negative predictive value (NPV) (95% CI: 89.9-97.1%), 3.1 positive likelihood ratio (PLR) (95% CI: 2.2-4.3), 0.3 negative likelihood ratio (NLR) (95% CI: 0.15-0.58), and 75.5% overall accuracy (95% CI: 68.8-81.4%) for identifying invasive ventilation needs. In contrast, SAS, with a cutoff point greater than 5, has an AUC of 0.67. It demonstrates 62.5% sensitivity, 61.9% specificity, 24.7% PPV, 89.2% NPV, and an overall diagnostic accuracy of 61.9%. The DeLong test confirms the significance of this difference (AUC difference: 0.142, p = 0.04), underscoring LUS's greater reliability for NIV failure.  Conclusion: This study underscores the diagnostic accuracy of the LUS cutoff of > 7 in determining invasive ventilation needs during the initial 72 h of NIV. Importantly, while lower LUS values typically rule out the need for ventilation, higher values, though indicative, are not definitive. What is known? • The effectiveness of lung ultrasound in evaluating disease severity and the need for surfactants in neonates with respiratory distress is well established. However, traditional indicators for transitioning from non-invasive to invasive ventilation, like respiratory distress and oxygen levels, have limitations, underscoring the need for reliable, non-invasive assessment tools. What is new? • This study reveals that a LUS over 7 accurately discriminates between neonates requiring invasive ventilation and those who do not. Furthermore, the lung ultrasound score outperformed the Silverman Andersen score for NIV failure in our population.

Feeding in Preterm Neonates With Antenatal Doppler Abnormalities: A Systematic Review and Meta-Analysis.

OBJECTIVES: In this systematic review and meta-analysis, we attempted to determine the most appropriate feed initiation and advancement practices in preterm neonates with antenatal Doppler abnormalities. METHODS: We included randomized controlled trials comparing different feed initiation and advancement practices in neonates with antenatal Doppler abnormalities. The databases of PubMed, Embase, Cochrane, CINAHL, Scopus, and Google Scholar were searched on February 25, 2022. The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RevMan 5.4 was used for data analysis. RESULTS: Of the 1499 unique records identified, 7 studies were eligible for inclusion (6 on feed initiation, 1 on feed advancement). Early enteral feeding did not increase NEC stage 2 or more [risk ratio (RR) 1.12, 95% confidence interval (CI) 0.71-1.78; 6 studies, 775 participants] and mortality (RR 0.83, 95% CI 0.47-1.48; 5 studies, 642 participants). A trend was noted towards an increase in feeding intolerance (RR 1.23, 95% CI 0.98-1.56; 5 studies, 715 participants). There was a significant reduction in age at full enteral feeds, duration of total parental nutrition, and rates of hospital-acquired infections. Rapid feed advancement decreased the age at full enteral feeds without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant. CONCLUSION: There is low-certainty evidence that early feed initiation in preterm neonates with antenatal Doppler abnormalities does not increase rates of NEC and mortality. There is insufficient data on the speed of feed advancement.

Comparison of CRIB-II with SNAPPE-II for predicting survival and morbidities before hospital discharge in neonates with gestation ≤ 32 weeks: a prospective multicentric observational study.

Various studies validated and compared Score for Neonatal Acute Physiology with Perinatal extension-II (SNAPPE-II) and Clinical Risk Index for Babies-II (CRIB-II) admission sickness severity scores for predicting survival, but very few studies compared them for predicting the morbidities in preterm infants. In this multicenter prospective observational study, SNAPPE-II and CRIB-II newborn illness severity scores were compared for predicting mortality and morbidities in infants with gestational age of ≤ 32 weeks. Major morbidities were classified as bronchopulmonary dysplasia, abnormal cranial ultrasound (presence of intraventricular hemorrhage grade III or more or periventricular leukomalacia grade II to IV), and retinopathy of prematurity requiring treatment. Combined adverse outcome was defined as death or any major morbidity. Comparison of the scoring systems was done by area under the curve (AUC) on receiver operating characteristics curve (ROC curve) analysis. A total of 419 neonates who were admitted to 5 participating NICUs were studied. The mortality rate in the study population was 8.8%. Both CRIB-II (AUC: 0.795) and SNAPPE-II (AUC: 0.78) had good predictive ability for in-hospital mortality. For predicting any one of the major morbidities and combined adverse outcome, CRIB-II had better predictive ability than SNAPPE-II with AUC of 0.83 vs. 0.70 and 0.85 vs. 0.74, respectively. CONCLUSION: In infants with gestational age of ≤ 32 weeks, both CRIB-II and SNAPPE-II are good scoring systems for predicting mortality. CRIB-II, being a simpler scoring system and having better predictive ability for major morbidities and combined adverse outcome, is preferable over SNAPPE-II. WHAT IS KNOWN: • SNAPPE-II and CRIB-II scores have good predictive ability on in-hospital mortality in preterm neonates. WHAT IS NEW: • SNAPPE-II and CRIB-II both have good predictive ability for mortality, but CRIB-II has better ability for short-term morbidities related to the prematurity.

Mortality and Morbidity in Premature Infants: An East and West Comparative Study.

OBJECTIVE: Survival of preterm infants differs dramatically depending on birthplace. No previous studies have compared outcomes of preterm infants between low middle-income and high-income countries such as India and the United States. The purpose of this study is to evaluate differences in care practices, resources, mortality, and morbidities in preterm infants with birth weight 700 to 1,500 g between two major neonatal centers in these countries. STUDY DESIGN: This is a retrospective cohort study with de-identified data from Fernandez Hospital (FH) in Hyderabad, India, and Texas Children's Hospital (TCH) in Houston, TX, for infants born January 2016 to December 2018, and weighing 700 to 1,500 g at birth. The primary outcome was death before hospital discharge. RESULTS: Of 1,195 infants, 736 were admitted to FH and 459 were admitted to TCH. After controlling for differences in gestational age, small for gestational age, and antenatal corticosteroid use, TCH patients had lower mortality before hospital discharge (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI]: 0.16-0.48, p < 0.001) and more bronchopulmonary dysplasia (BPD; aOR = 2.2, 95% CI: 1.51-3.21, p < 0.001). The composite outcome of death or BPD and death or any major morbidity (BPD or intraventricular hemorrhage grade II or more or periventricular leukomalacia grade II or more or retinopathy of prematurity requiring treatment) were not different. CONCLUSION: In this study, TCH infants had decreased odds of death before hospital discharge compared with FH but higher odds of BPD, which may be related to increased survival and differences in care practices. KEY POINTS: · Few studies compared outcomes of premature infants between different high-income countries.. · There are no studies comparing preterm infants between low middle-income and high-income countries such as India and the United States.. · This study evaluated detailed comparison of care practices and infrastructure of NICUs in India and United states..

Plethysmography variability index (PVI) changes in preterm neonates with shock-an observational study.

Shock is an acute state of circulatory dysfunction. The diagnosis of shock is complex in neonates. The relative sensitivity of current clinical or laboratory findings for detecting shock is largely unknown, especially for preterm neonates. For preload assessment, inferior vena cava (IVC) collapsibility can be a useful bedside echocardiography parameter. plethysmography variability index (PVI) is a marker of fluid responsive shock in adults and children, but not well defined in neonates. In this prospective observational study, we evaluated the changes in PVI in preterm neonates with shock. Among the 37 infants enrolled in the study, the mean blood pressure (MAP) was 45 (± 4 mm of Hg) and none of infants had hypotension. The mean pulse pressure was 28 mm of Hg, the mean PVI was 28% (±5), the mean arterial blood gas pH was 7.20 (±0.07), and the mean base deficit was 9.9 (±2.53) at the onset of shock. Thirty (96.77%) of the 31 infants with resolution of shock showed decrease in PVI with an average decrease of 11% (±5).Conclusion: Significant proportion of neonates show an increase in PVI at the onset of shock. What is Known: • Plethysmography Variability Index (PVI) is commonly used as a marker of volume status in paediatric population. • Changes in PVI may guide in giving volume boluses in patients with shock. What is New: • This study provides information of changes in PVI in preterm neonates with shock. • PVI may become a valuable tool to be used at bedside in preterm infants with shock.

Oral Paracetamol vs Oral Ibuprofen in Patent Ductus Arteriosus: A Randomized, Controlled, Noninferiority Trial.

OBJECTIVE: To test the hypothesis that oral paracetamol is non-inferior to oral ibuprofen in closing hemodynamically significant patent ductus arteriosus (hsPDA) with an a priori noninferiority (NI) margin of 15%. STUDY DESIGN: Multicenter, randomized, controlled, NI trial conducted in level III neonatal intensive care units. Consecutively inborn preterm neonates of <32 weeks of gestation with hsPDA were included. Those with structural heart disease, major malformations, and contraindications for enteral feeding or for administration of study drugs were excluded. Interventions included oral paracetamol in the experimental arm and oral ibuprofen in the active control arm. The primary outcome was closure of hsPDA by 24 hours from the last dose of the study drug. Secondary outcome measures included closure of hsPDA by 24 hours after the first course of the study drug, rate of reopening after the first course, and adverse events associated with the study drug. RESULTS: Out of 1250 neonates screened, 161 were randomized. Oral paracetamol was noninferior to oral ibuprofen in closure of hsPDA by both per protocol analysis (62 [95.4%] vs 63 [94%]; relative risk [RR], 1.01 [95% CI, 0.94-1.1]; risk difference [RD], 1.4 [95% CI, -6 to 9]; P = .37) and intention-to-treat analysis (63 [89%] vs 65 [89%]; RR, 0.99 [95% CI, 0.89-1.12]; RD, -0.3 [95% CI, -11 to 10]; P = .47). All adverse events were comparable in the 2 study arms. CONCLUSIONS: Oral paracetamol is noninferior to oral ibuprofen for the closure of hsPDA in preterm neonates of <32 weeks of gestation. No difference was observed in the adverse events studied.

Echocardiographic assessment of hemodynamic changes in preterm neonates with shock: a prospective pragmatic cohort study.

Shock is a state of circulatory dysfunction and its diagnosis is complex in neonates. Hemodynamic assessment using echocardiography has potential to guide better management regimes in neonates with shock. Objective of this study is to analyze changes in the echocardiographic parameters in preterm neonates with shock at presentation and after resolution. In this prospective pragmatic Cohort study, eligible neonates with shock were monitored for changes in echocardiographic parameters at onset of shock and after resolution of shock. Paired data analysis was done for observed changes in the parameters. Based on initial clinical parameters and echocardiographic parameters, infants were assigned into different types of shock. Data of 37 infants were analyzed for baseline clinical and echocardiographic parameters, and data of 31 infants were analyzed for the changes in the observed parameters after shock resolution. Statistically significant changes were observed in inferior vena cava collapsibility index (ICI), left ventricular end diastolic volume (LVEDV), isovolemic ventricular relaxation time (IVRT), left and right ventricular stroke volume, and ejection fraction (EF). There was no agreement between clinical and echocardiographic definitions of shock.Conclusion: We noticed shock has overlapping pathophysiologic features. Our study highlights the importance of baseline documentation of echocardiographic parameters of all infants who are at risk of shock and repeat echocardiography at onset of shock to observe the changes in ICI, LVEDV, IVRT, stroke volume, and EF. This would guide pathophysiological management of shock in neonates. What is Known: • In neonates pathophysiology of shock is overlapping. • Echocardiography can help in better understanding and management of shock. What is New: • Study gives median changes in major echocardiographic parameters in neonatal shock. • These changes can guide for selection of volume and inotropes in management.

The impact of a quality improvement project to reduce admission hypothermia on mortality and morbidity in very low birth weight infants.

This prospective observational study was aimed to analyze the impact of a quality improvement project to reduce admission hypothermia on composite outcome of neonatal mortality and major morbidities. Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between January 2018 and January 2020 who were admitted directly from delivery room to NICU were included in the study. Study period was divided in three phases including pre-intervention, intervention and post-intervention phase. There were a total of 368 VLBW infants included in the study. Mean admission temperature of neonates was 35.3 ± 0.6 °C, 36.0 ± 0.8 °C, and 36.4 ± 0.4 °C during pre-intervention, intervention, and post-intervention phase, respectively. Absolute incidence of composite outcome was 31%, 20%, and 13.2% during pre-intervention, intervention, and post-intervention phase, respectively. Risk of adverse composite outcome was significantly lower in post-intervention period as compared to pre-intervention period (aRR 0.68, 95% CI 0.49-0.92). Nosocomial sepsis and need for invasive ventilation was also significantly less in post-intervention period as compared to pre-intervention period.Conclusion: Implementation of thermoregulatory interventions best suited to local settings help in significant reduction of neonatal hypothermia, which in turn can help to improve neonatal outcomes. What is known: • Admission hypothermia is associated with adverse neonatal outcomes. • Implementation of quality improvement projects help reducing hypothermia incidence. What is new: • Implementation of quality improvement project to reduce admission hypothermia resulted in reduction in incidence of adverse composite neonatal outcome. • Also implementation of quality improvement project led to reduction in incidence of nosocomial sepsis and need of invasive ventilation.

Predictors of length of hospital stay among preterm infants admitted to neonatal intensive care unit: Data from a multicentre collaborative network from India (INNC: Indian National Neonatal Collaborative).

AIM: Prediction of length of stay (LOS) among preterm neonates is important for counselling of parents and for assessing neonatal intensive care unit (NICU) census and economic burden. The aim of this study is to evaluate perinatal and postnatal factors that influence LOS in preterm infants (25-33 weeks of gestation) admitted to participating NICUs of Indian National Neonatal Collaborative (INNC). METHODS: From the INNC database, the data which were prospectively entered using uniformed pre-defined criteria were analysed. RESULTS: A total of 3095 infants were included from 12 centres. Every week decrease in gestation increased LOS by 9 days. The median LOS for infants with gestational age of 25, 26, 27, 28, 29, 30, 31, 32 and 33 weeks were 86, 70, 62, 52, 40, 30, 23, 16 and 10 days, respectively. On multivariate analysis, abnormal antenatal umbilical artery doppler, severe small for gestational age (SGA), requirement of resuscitation, respiratory distress syndrome (RDS), seizures, sepsis, necrotising enterocolitis (NEC), major malformations and bronchopulmonary dysplasia (BPD) increased LOS by 5.4 (3.5-7.4), 21.6 (19-23.9), 4.7 (3.3-6.1), 3 (1.7-4.3), 15.2 (8.5-22.1), 11.2 (9.1-13.2), 9.8 (5.2-14.4), 8.8 (4.4-13.3) and 5.6 (0.5-10.7) days, respectively. CONCLUSIONS: Apart from lower gestation and birth weight, abnormal antenatal umbilical artery doppler, severe SGA, resuscitation need, major malformations, RDS, seizures, sepsis, NEC and BPD influenced LOS in preterm infants. In comparison with other networks or data from developed countries, LOS in our network was comparatively less for similar gestational age infants.

Accuracy of Bilistick (a Point-of-Care Device) to Detect Neonatal Hyperbilirubinemia.

INTRODUCTION: Early diagnosis and appropriate management of neonatal jaundice is crucial in avoiding severe hyperbilirubinemia and brain injury. A low-cost, minimally invasive, point-of-care (PoC) tool for total bilirubin (TB) estimation which can be useful across all ranges of bilirubin values and all settings is the need of the hour. OBJECTIVE: To assess the accuracy of Bilistick system, a PoC device, for measurement of TB in comparison with estimation by spectrophotometry. DESIGN/METHODS: In this cross-sectional clinical study, in infants who required TB estimation, blood samples in 25-µl sample transfer pipettes were collected at the same time from venous blood obtained for laboratory bilirubin estimation. The accuracy of Bilistick in estimating TB within ±2 mg/dl of bilirubin estimation by spectrophotometry was the primary outcome. RESULTS: Among the enrolled infants, 198 infants were eligible for study analysis with the mean gestation of 36 ± 2.3 weeks and the mean birth weight of 2368 ± 623 g. The median age at enrollment was 68.5 h (interquartile range: 48-92). Bilistick was accurate only in 54.5% infants in measuring TB within ±2 mg/dl difference of TB measured by spectrophotometry. There was a moderate degree of correlation between the two methods (r = 0.457; 95% CI: 0.339-0.561, p value < 0.001). Bland-Altman analysis showed a mean difference of 0.5 mg/dl (SD ± 4.4) with limits of agreement between -8.2 and +9.1 mg/dl. CONCLUSION: Bilistick as a PoC device is not accurate to estimate TB within the clinically acceptable difference (±2 mg/dl) of TB estimation by spectrophotometry and needs further improvement to make it more accurate.

Nasal injury and comfort with jet versus bubble continuous positive airway pressure delivery systems in preterm infants with respiratory distress.

Nasal injuries with use of nasal continuous positive airway pressure (CPAP) range from blanching of nasal tip to septal necrosis and septal drop. This analysis was done in preterm neonates of < 34-week gestation, who received nasal CPAP as primary support as part of a randomized trial comparing Jet device with Bubble device for delivery of CPAP, both through nasal prongs of different structure, make and fixation methods. Nasal injury was assessed using a validated nasal injury score. Out of 170 neonates enrolled, 103 (61%) had nasal injuries; moderate and severe injuries were observed in 18 (11%) and 8 (5%) infants, respectively. Septum was the most common site injured. The incidence and severity of nasal injury were significantly lesser in Jet group compared to Bubble group [RR 0.6 (95% C.I. 0.5-0.8); p < 0.001]. Similarly, neonates in Jet group had lesser average [median (IQR): 3 (3,4) vs. 4 [8, 14]; p = 0.04] as well as peak N-PASS pain scores [median (IQR): 4 [8, 14] vs. 5 [13, 16]; p = 0.01] in comparison to Bubble group. However, Jet group neonates had significantly more common prong displacements. CONCLUSION: Bubble CPAP device with its nasal interface had higher and more serious incidence of nasal injuries in comparison to Jet CPAP device. What is known: • Nasal injuries are becoming increasingly common with use of nasal CPAP low gestational age, low birth weight, longer use of CPAP and longer NICU stay are risk factors for such injuries • Validated nasal injury scores have been created for assessment of nasal trauma in neonates What is new: • Bubble device with its interface had higher and more serious incidence of nasal injuries in comparison to Jet device • Even though pain assessed by N-PASS was less with Jet device, prong displacements were more frequent with its system.

Use of real-time ultrasound for locating tip position in neonates undergoing peripherally inserted central catheter insertion: A pilot study.

BACKGROUND & OBJECTIVES: Securing long-term venous access is an essential part of sick newborn care. The malposition of central line tip leads to several complications. There is a need for an easily available bedside investigating tool to diagnose these malpositions. This study was done to compare the effectiveness of real-time ultrasound (RTUS) with X-ray in identifying the peripherally inserted central catheter (PICC) line tip. METHODS: This pilot observational study was conducted in a level III Neonatal Intensive Care Unit of a tertiary care hospital in India, from June 2012 to June 2013. A total of 33 PICC lines in 31 infants were included in the study. After insertion of PICC line, X-ray and RTUS were done to locate the tip of the PICC line. RESULTS: In this study, PICC line tip could be identified by bedside RTUS in 94 per cent of line insertions. Standard X-ray identified the tip in all cases. RTUS has been shown to have good diagnostic utility in comparison with X-ray with sensitivity and specificity being 96.55 and 100 per cent, respectively. In our study, majority of malpositions were identified and manipulated by RTUS, thus second X-rays were avoided. INTERPRETATION & CONCLUSIONS: The result of this pilot study shows that RTUS may be a reliable and safe bedside tool for determining the tip of PICC lines. However, studies with large sample size need to be done to confirm these findings.

Immediate neonatal outcomes of preterm infants born to mothers with preterm pre-labour rupture of membranes.

Background & objectives: With the use of early and appropriate use of antibiotics, outcomes have improved in the mother-infant dyads exposed to preterm pre-labour rupture of membranes (PPROM). This study was undertaken to evaluate immediate neonatal outcomes in infants born before 33 completed weeks of gestation to mothers with PPROM versus without PPROM. Methods: During the study period from January 2013 to December 2013, a total of 182 mother-infant dyads were prospectively included in the study. Among the enrolled, 69 were in the PPROM group and 113 in the control group (no PPROM). Mother-infant dyads in PPROM group were covered with antibiotics. The primary outcome was the combined adverse neonatal outcome consisting of sepsis, necrotizing enterocolitis >Stage II or pneumonia or oxygen at day 28 or cystic periventricular leucomalacia or mortality before discharge. Results: Baseline maternal and neonatal variables were comparable across the two groups, except for higher incidence of singletons, maternal pregnancy-induced hypertension (PIH) in the control group and higher proportion of males, complete steroid coverage and oligohydramnios in the PPROM group. The proportion of infants with combined adverse neonatal outcome was similar between the two groups [odds ratio (OR): 1.43; 95% confidence interval (CI): 0.77-2.6]. Both the groups were comparable for most other neonatal morbidities and outcomes, except screen-positive sepsis (OR: 3.7; 95% CI: 1.17-11.5) which was higher in PPROM group. Interpretation & conclusions: Mothers with PPROM and their newborns when treated with timely and appropriate antibiotics had neonatal outcomes similar to those not exposed to PPROM.

Construction of Ductal Diameter Centiles in the First 24 h of Life and Their Relation to Cerebral Blood Flow in Neonates Weighing Less Than 1250 g in the First 24 h of Life.

AIMS AND OBJECTIVES: To evaluate the ductal diameter centiles in the first 24 h of life and their relation to cerebral blood flow in neonates weighing <1250 g in the first 24 h of life. METHOD AND MATERIAL: This prospective observational cohort study enrolled 44 infants with birth weight <1250 g. Two-dimensional echocardiography and color Doppler were performed within the first 12 h of life and were repeated again in the next 12 h of life to assess the ductal size and middle cerebral artery (MCA) flows [peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (MV) and pulsatility index (PI)]. RESULTS: The mean patent ductus arteriosus (PDA) size (mm) within 0-6 h was 1.88 ± 1.12, within 7-12 h was 2.02 ± 0.973, within 13-18 h was 1.47 ± 1.00 and within 19-24 h was 1.42 ± 0.705. There was a significant increase in the PSV and MV of the MCA in infants with open PDA compared with those with closed PDA (p < 0.05) when measured between 13 and 24 h of life. There was no correlation between the PDA size and simultaneous PSV, EDV, MV and PI of MCA within 12 h of life. The PDA size within 13-24 h showed correlation with only the PSV of the MCA (p = 0.05) and not with the EDV, MV and PI. There was no significant difference in the PSV, EDV, MV and PI among the infants depending on the size of the PDA. CONCLUSION: There is a progressive decrease in the PDA size in the first 24 h of life. The PSV and MV of the MCA are increased in infants with closed PDA, but among those with open PDA, size does not relate to MCA flows in the first 24 h of life.

The effect of kangaroo ward care in comparison with "intermediate intensive care" on the growth velocity in preterm infant with birth weight <1100 g: randomized control trial.

UNLABELLED: Kangaroo mother care (KMC) reduces neonatal mortality, neonatal sepsis and improves growth outcome in preterm infants. In this study, we compared the efficacy of "baby care in kangaroo ward (KWC)" with "baby care in intermediate intensive care (IIC)" in stable preterm infants (birth weight <1100 g) for improving the growth velocity till term corrected age. One hundred and forty-one infants were randomized to KWC (n = 71) or IIC (n = 70) once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to the KWC immediately after randomization and those in the IIC group were given care in the IIC till they attained a weight of 1250 g and then shifted to the KWC. The average weight gains as well as weight, length, and head circumference at term corrected age were comparable in both the groups. There was significant reduction in IIC stay post randomization and increase in weight gain before discharge in the KWC group. There was a significant increase in incidence of apnea in the IIC group. CONCLUSION: Early KWC is equally efficacious as IIC in improving the growth outcomes of stable preterm (birth weight <1100 g) infants at term gestational age. CLINICAL TRIAL REGISTRATION: Clinical trial registry of India CTRI/2014/05/004625 WHAT IS KNOWN: • Kangaroo mother care (KMC) reduces neonatal mortality, neonatal sepsis and improves growth outcome in VLBW infants. What is new: • Baby care by mother can be given safely in kangaroo ward from a weight of 1150 g in stable preterm infants without any adverse effects.

Initiating nasal continuous positive airway pressure in preterm neonates at 5 cm as against 7 cm did not decrease the need for mechanical ventilation.

AIM: The optimum starting nasal continuous positive airway pressure (nCPAP) for infants on bubble nCPAP is unknown. We compared whether an initial bubble nCPAP of 7 cm rather than 5 cm of water prevented the need for mechanical ventilation among preterm neonates with respiratory distress. METHODS: Preterm neonates born at 27-34 weeks with the onset of respiratory distress within 24 hours of birth were randomised to receive high or standard nCPAP at either 7 cm or 5 cm of water, respectively. The primary outcome was the need for mechanical ventilation in the first week of life. RESULTS: The baseline characteristics were comparable between the two groups. The proportion of infants who required mechanical ventilation during the first week of life was similar between the two groups (standard 29/133, 21.8% versus high 30/138, 21.7%), with a relative risk of 0.99 and range of 0.56-1.77. The secondary outcomes were similar between the two groups, including mortality before discharge, pulmonary air leaks, need of surfactant therapy, bronchopulmonary dysplasia and duration of nCPAP. CONCLUSION: Initiating nCPAP at a higher pressure of 7 cm in preterm neonates with respiratory distress, rather than the standard 5 cm, did not decrease the need for mechanical ventilation during the first week of life.

Intermittent versus continuous phototherapy for the treatment of neonatal non-hemolytic moderate hyperbilirubinemia in infants more than 34 weeks of gestational age: a randomized controlled trial.

UNLABELLED: Intermittent phototherapy with "12 h on and then 12 h off" schedule in comparison with continuous phototherapy for neonatal hyperbilirubinemia may save costs and decrease anxiety of parents. In this non-inferiority-randomized controlled trial, healthy late preterm (>34 weeks) and term neonates with neonatal hyperbilirubinemia under phototherapy for 8 h and total serum bilirubin (TSB) < 18 mg/dL were randomized either into intermittent (IPT) or continuous (CPT) group. Infants in IPT group received 12 h on and 12 h off cycles of phototherapy. In both arms, phototherapy was continued until TSB < 13 mg/dL. Primary outcome was rate of fall of bilirubin. Seventy-five infants (IPT n = 36 vs. CPT n = 39) were enrolled in the study. The rate of fall of bilirubin was significantly higher with "IPT" phototherapy (p = 0.002). CONCLUSION: In term and late preterm infants with non-hemolytic moderate hyperbilirubinemia, intermittent phototherapy with 12 h on and 12 h off cycles is as efficacious as continuous phototherapy.

Disposable diapers decrease the incidence of neonatal infections compared to cloth diapers in a level II neonatal intensive care unit.

OBJECTIVE: To study whether disposable diapers decrease the incidence of neonatal infections compared with cloth diapers in a level II neonatal intensive care unit (NICU). METHOD AND MATERIAL: All neonates admitted to the NICU and having duration of stay >48 h were enrolled. Those babies with signs and symptoms of infection were screened with septic screen and/or blood culture. RESULTS: The primary outcome of the study was incidence of probable sepsis. Of 253 babies enrolled in the study period, probable sepsis was present in 101 (39.9%) infants in the total study group and was higher in cloth diaper group as compared with disposable diaper group (p = 0.01). For an average NICU stay of 6 days, cloth diapers would cost Rs. 241 vs. Rs. 162 for disposable diaper for any infant. CONCLUSION: Usage of disposable diapers decrease the incidence of probable sepsis in babies admitted to NICU. It is also cost effective to use disposable diapers in the NICU.